Association of operative approach with adverse events following hepatic resections

Despite growing use of minimally invasive surgery (MIS) for hepatocellular carcinoma (HCC), contemporary national data contrasting MIS with open hepatectomy are sparse.

Adults (≥18 y) undergoing hepatectomy for HCC in the American College of Surgeons National Surgical Quality Improvement Program (2015-2022) were studied. MIS (laparoscopic or robotic) resections were compared with open operations. Entropy balancing harmonized covariates, and multivariable logistic or linear models produced adjusted odds ratios (AOR) for major adverse events (MAE; composite of mortality and serious complications), liver-specific complications, and 30-day readmission.

Among 5832 hepatectomies, 27.0 % were MIS, rising from 18.8 % in 2015 to 36.1 % in 2022 (p < 0.001). After adjustment, MIS was associated with markedly lower odds of MAE (AOR 0.36, 95 % CI 0.29-0.46), postoperative liver failure (AOR 0.34, 0.20-0.58), bile leak (AOR 0.49, 0.28-0.89), need for invasive intervention (AOR 0.29, 0.18-0.47), and 30-day readmission (AOR 0.61, 0.44-0.86). In the subset undergoing major resections, MIS retained protective associations for MAE (AOR 0.26, 0.15-0.46) and readmission (AOR 0.28, 0.11-0.80).

In a large, contemporary U.S. cohort, MIS hepatectomy was independently associated with fewer perioperative complications, liver-specific adverse events, and readmissions compared with open surgery-even for major resections. These findings support continued expansion of minimally invasive hepatectomy and targeted training to extend its benefits to appropriately selected patients with resectable HCC.